NYC & LA Hemorrhoid Surgeon

Case Study:

“I was always more of a top, but met someone who requested some role reversal. That first night was intimate and exactly what we had both hoped for. Anal intercourse didn’t hurt that evening and it was the most sensual bottoming experience I had ever had. With that said, my happy ending didn’t last long.  The next morning, I awoke with what I thought was a grape on the rim of my anus. It was quite painful and progressed over the subsequent days. I finally decided it was time to see my primary care physician and was placed on local steroid ointment and Motrin. Along with Epsom salt baths, the immediate hemorrhoid improved; however, over the next couple of months, recurring episodes and flare ups caused me to seek an anal surgeon in New York, who not only specialized in hemorrhoids, but also understood why bottoming caused the hemorrhoid initially and how I could prevent it from happening again.  I felt so at ease with Dr. Goldstein during my consultation. I knew I wouldn’t be judged expressing how the hemorrhoid caused me such grief and I can’t express how glad I was to finally get rid of it. Not to mention, because of Dr. Goldstein’s complete understanding of the male body, the aesthetics are back to being “top” notch, too.”

What is a hemorrhoid?

Hemorrhoids result from increased pressure in the veins of the anus causing them to bulge and expand, leading to significant pain, swelling, and bleeding. The most common cause is constipation and straining during bowel movements, sitting for prolonged periods of time, and/or anal intercourse.  Two different types of hemorrhoids can occur: external or internal.  More than 90% heal without surgery, and you will be given an appropriate bowel regimen and topical creams to provide relief as they heal.  However, hemorrhoids that become chronic may require surgical treatment.

What are the symptoms of hemorrhoids?

While both external and internal hemorrhoids may cause bleeding, localized swelling, and thrombosis, the key difference between the two is that external hemorrhoids generally cause pain while internal do not.  Sometimes external thrombosed hemorrhoids develop skin tags in the region due to the overlying skin being stretched. See skin tag.

How are hemorrhoids diagnosed?

Most external hemorrhoids can be diagnosed via clinical inspection, while internal hemorrhoids are examined by anoscopy.

What is the treatment for hemorrhoids?

Non-Surgical Hemorrhoid Treatments

There are ways to attempt to treat hemorrhoids from home. The appropriate initial non-surgical regimen to treat hemorrhoids consists of:

  • Over-the-counter stool softeners, such as Colace, three times daily
  • Over-the-counter fiber supplements, such as Metamucil
  • Sitz baths, utilizing over-the-counter epsom salts
  • Proctozone 2.5% or a similar steroid, a prescription topical anal ointment, should be applied as directed by your physician.
  • Boosting your fiber intake with choices such as grains and whole-grain products, fruits, vegetables, legumes, nuts, and seeds
  • Increasing your overall water intake to 8-12 ten ounce glasses per day
  • Keeping the anal area clean and dry. Wash gently with warm soapy water, and pat dry.
  • Limiting the use of toilet paper, as wiping causes local inflammation. Please refrain from using baby wipes or medicated pads for prolonged periods, and do not spend more time sitting on the toilet than necessary.


Anal pathology takes time to heal. You can imagine that every time it is attempting to improve, another local trauma/bowel movement occurs. Do not try to avoid having bowel movements, and try not to get frustrated as you work on the above regimen. We will see you in 2-3 weeks from initial diagnosis to see what improvement has occurred. Surgery is the last option in our management.

Anal Hemorrhoid Surgical Treatment

Hemorrhoid treatments are very effective, but unless dietary and lifestyle changes are made, they may recur. If symptoms persist or are severe, an anal hemorrhoid surgeon may be required to provide one of the following treatments:

Cauterization. Using either an electric probe, a laser beam, or an infrared light, a burn seals the end of the hemorrhoid, causing it to close off and shrink.

Banding. Prolapsed internal hemorrhoids are often removed using rubber-band ligation in the office. A special instrument secures a tiny rubber band around the hemorrhoid shutting off its blood supply, causing it to fall off within a week. Banding is not an option for large internal hemorrhoids or ones that encroach externally. If placed on ones with that mild muscle or external component, it can be quite uncomfortable and without efficacy.

Anal Hemorrhoid Surgery. For large internal hemorrhoids, uncomfortable external hemorrhoids, mild thrombosed hemorrhoids, or mild hemorrhoids with large remaining skin tags, a hemorrhoidectomy is warranted by an anal hemorrhoid surgeon. Formal hemorrhoidectomy is a wonderful approach in the gay community, since it allows also for removal of tags and restoration of the canal to allow for maximal pleasure, with the aesthetics one desires. Another anal hemorrhoid surgical option is called the procedure for prolapsed hemorrhoids (PPH). This is using a circular device and stapling the hemorrhoidal tissue in a 360 degree manner. It is highly effective, though in the anal intercourse world it is not recommended since the staple line internally will be present; leading to irritation, pain, and an adverse outcome for the giver.

Bespoke Surgical has offices in Beverly Hills, LA and Lower Manhattan, New York City that provide hemorrhoid surgical solutions. If you’re looking for a hemorrhoid surgeon, contact our offices today.


  • Dr. Evan Goldstein, D.O.

    Dr. Evan Goldstein, D.O.

    Read Bio